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Framework for Effective Board Governance of Health System Quality

The Institute for Healthcare Improvement (IHI) newly released a white paper, Framework for Effective Board Governance of Health System Quality. The Governance Institute provided resources and research to support this project, and participated in an expert panel to help develop the quality governance framework described in the paper. The IHI white paper comes with an accompanying Governance of Quality Assessment (GQA) Online Tool, which outlines specific oversight responsibilities and concrete actions trustees can take to achieve them. The purpose of the assessment is to help trustees compare what they’re doing now to what they could be doing to oversee all dimensions of health care quality.

Prior research has shown a correlation between how well health care systems perform on quality measures — evidence-based processes that improve outcomes — and the board’s demonstrated focus on quality of care. Until now, however, resources and programs to educate and engage health care trustees have focused heavily on hospital settings and on patient safety. While those are still important concerns, broader attention is warranted.

“Our research revealed a real need for both better and more consistent guidance around the core health care knowledge in quality that governing boards should have and for a practical way to assess and extend board oversight to all quality domains,” said Beth Daley Ullem, MBA, lead author of the new framework and assessment tool. “Health care quality encompasses the entire care continuum, especially outpatient settings, and there is a growing need for trustee oversight of efforts to address areas such as population health; equity in care delivery, access, and quality; mental health and addiction; and the prohibitive costs of care for many patients and families.”

The new tools are meant to help health system trustees — some 80,000 in the US alone — make sense of this expanding universe of accountability and how to navigate it. The guidelines also help standardize and prioritize what, more precisely, trustees need to better master to ensure their organizations live up to stated commitments to high quality.

This work was a collaboration of IHI’s Research and Development team and Lucian Leape Institute (LLI), an initiative of IHI. Their research included in-depth interviews, literature review, and the insights of an expert panel. It was funded by an unrestricted educational grant from Medtronic, inaugural funder of LLI.

Get your copy of Framework for Effective Board Governance of Health System Quality →

The authors are grateful to the IHI Lucian Leape Institute members, whose leadership identified the need for support for trustees and health system leaders in governance of quality. We also thank the experts interviewed for this work and the in-depth contributions of the expert group that developed and revised the framework and assessment tool, including Kathryn C. Peisert, Managing Editor, The Governance Institute. This work was created through collaboration with many leading health care and governance organizations, including the American Hospital Association, The Governance Institute, and the American College of Healthcare Executives. Finally, the authors thank Jane Roessner and Val Weber of IHI for their thoughtful editorial review of this white paper and the IHI thought leaders who, over the years, have advanced board commitment to quality.